I have unfortunately spent quite a bit of time in the hospital over the last 4 years.
In all the hospitals I found the same short comings. They are sterile and cold, the food is not only sub par but not ideal for promoting healing. Ill stop there for now but I have found from personal experience that the above concerns can have a great impact on health.
My question is, is this all about the money? I just feel like patient care could be taken to new heights by incorporating some pretty basic things.
I know, I know, I am idealistic and ignorant to the reality of health care as a business but I would love to understand the in's and out's of the business side (I have a finance degree and see myself heading that way eventually)
What would you recommend as a resource to help understand for profit health care in the United States? I would like to learn about old issues that have plagued the system for a long time and new ones as well. I would really love to get an understanding of how the national health care act has effected hospitals as well; good or bad.
I would love to know who would be ideal to talk to in a hospital that could guide me.
Specializes in NICU, PICU, Transport, L&D, Hospice.
I believe that we are obligated to educate patients and their families about expected outcomes of their chronic diseases whether or not they initiate the discussion. We also, as health professionals must address end of life issues and the notion of palliative care and hospice, again, regardless of whether or not the patient and/or family has initiated the discussion. It is our job to provide people with the information that they require to make informed decisions. Many of us have experienced the wrath of the family who does not want to hear that their loved one is dying. Many of us know that such wrath does not remove our obligation to provide them and the patient specifically with ALL of the facts surrounding their illness and the likelihood of recovery or death. For too long the medical field has preferred to sugar coat talk of death after waiting until the very last moment in care to discuss it. That practice is outdated, centered on the professional rather than on the needs of the patient, and is costing our health system millions of $$ in futile care.
Yes, there will be some folks who are "not ready" to hear about palliative care or hospice yet. But we mention it anyway and by the time we mention it AGAIN, some of them have changed their minds or are ready to hear more information. People don't always know what they need to know. Some of them are under the impression that they "have time" to make the choices about hospice when they really don't have much time at all and they are wasting their time and resources trying to keep living when all they are doing is trading their comfort and peace for a vague sense of "hope".
Hello. I should have clarified this statement; otherwise you are absolutely correct.
What I meant was for people to pick food over scripts, not hospitals.
For instance, I was diagnosed with ocular rosacea, rosacea on my face, seborrheic dermatitis and high blood pressure and high cholesterol. It wasn't long before I realized what the Dr.'s had me on was crap and was making my quality of life worse. I turned inside and changed things up complete, I no longer have any of the above problems but the BP, its a bit elevated a 135/70 but I am off the beta's and now on a 5mg CCB.
There is a real awakening among people with common disorders like diabetes, high blood pressure, high cholesterol etc to turn away from tradition meds and seek out other methods. Look at Lipitor, massive lawsuit against Pfizer, the drug not only gives people diabetes (which apparently they knew) but the artificially lowering of cholesterol is shown not to even help people. Recent research shows that the cholesterol is a good thing b/c it is patching week spots in there arterial wall due to inflammation....inflammation most likely cause by diet. In my case it was, my cholesterol after 5 months plummeted, not by the use of drugs but by diet.
Pipe dream, maybe, but with results like mine its a dream worth having and pushing forward.
I'm glad you had a good experience, but, as the old saying goes, the plural of "anecdote" isn't "data." As far as hospital food goes, I guess you've had some bad experiences in that regard but, again, that doesn't mean it's a universal problem. I've worked in several hospitals over the years that served tasty, healthy food. At my current employer (a major academic medical center), the food is delicious and, as someone else already commented, the main complaint about the food is that there aren't enough unhealthy, "junk food" choices available.
While various practitioners may believe that providing these expensive treatments are not the best care, that opinion is only valid for themselves. The patient has his/her own values, may wish to prolong his/her life, and is the only person who can determine what constitutes quality of life for them. Provide sufficient information about all options for care, what the treatments/procedures involve, risks/benefits, other alternatives, and then the choice/decision is the patient's (often with the help of their family member/s) to make. The only person who can determine whether the effort and personal suffering involved in any procedure/treatment makes the procedure/treatment worth undergoing, is the person living the life, or (if the person is unable to make decisions for themself) a carefully chosen health care decision maker or close family member who knows the patient's wishes and whom the patient would wish to be involved in their care. Be very careful of assuming that patients will want what you think is best for them. Not every patient wishes to receive, or even consider, palliative care or hospice care at the time a nurse/physician thinks they should.
As far as having conversations with patients and family to push palliative care, unless the patient or their family initiates this discussion, or obviously wishes to participate in the discussion, I strongly suggest waiting until the patient or their family indicates that they would welcome this discussion. Of course, that time may never come. But be prepared for a great deal of resistance, and even hostility, if you prematurely and insensitively bring up the subject of closing the door to curative care before the patient and their family are really ready to do this.
I respectfully disagree. Many patients make very bad choices for themselves and their families.My FIL had end state COPD and wanted to be coded and put on a vent if the need arose. I don't think there's an argument to be made for following through with initiating a full code. He was never going home and had barely enough muscle mass left to lift his chest. Just because the patient wants something doesn't mean he should have it. Patients will ask for cancer drugs that will only advance their lives 28 days or so. The costs are extraordinary. If you asked me if I wanted a$16,000 drug for my advanced cancer or $16,000 cash to leave my family, there would be no way I would choose the extra 28 days if that meant my kid could spend it on college. Now, I realize that is not the exact choice given to me, but it puts my bad decision in perspective. I wouldn't ask ANYONE to pay that kind of money for an extra month of life.
There is an interesting article in Health Leaders Media titled "Hospitals' Fear of 30-Day Penalties May Speed Hospice Admissions", dated June 6, 2013.
The federal government cannot run out of money.
Nurses are not bound by duty to force information on patients if they indicate they do not wish to hear the information, or to insist that patients make choices about palliative care or hospice if they are not ready to. In my opinion this is against our Nurse's Code of Ethics.
There are situations when curative care will no longer yield positive results for certain people. That is indisputable. But even in these situations, I do not believe in forcing information on people that they are unready to receive, or pressuring people into making choices about palliative care that they are unready to make. These discussions, when truly appropriate, must be done considerately, not coercively or forcefully, with respect shown for the patient's/family's choices and decisions. If the patient/family say they do not wish to have the discussion, there is your answer, and it is to be respected. If the patient/family say they wish to continue to pursue curative care; there is your answer. The patient, with chronic illnesses, has the right to make their own decision, without being continuously questioned and prompted to choose palliative care or hospice.
I respectfully disagree. Many patients make very bad choices for themselves and their families.My FIL had end state COPD and wanted to be coded and put on a vent if the need arose. I don't think there's an argument to be made for following through with initiating a full code. He was never going home and had barely enough muscle mass left to lift his chest. Just because the patient wants something doesn't mean he should have it. Patients will ask for cancer drugs that will only advance their lives 28 days or so. The costs are extraordinary. If you asked me if I wanted a$16,000 drug for my advanced cancer or $16,000 cash to leave my family, there would be no way I would choose the extra 28 days if that meant my kid could spend it on college. Now, I realize that is not the exact choice given to me, but it puts my bad decision in perspective. I wouldn't ask ANYONE to pay that kind of money for an extra month of life.
I respect your opinion, but I believe patients and their families, once given sufficient information, have the right to make their own choices.
In your own particular case, you have the right to choose for yourself, as each person does, whether or not to undergo a course of treatment that will cause a financial burden for you.
I respect your opinion, but I believe patients and their families, once given sufficient information, have the right to make their own choices.
In your own particular case, you have the right to choose for yourself, as each person does, whether or not to undergo a course of treatment that will cause a financial burden for you.
Individuals have the right to make their own choice from among the treatent options presented to them, but there is no US law that requires hospitals or physicians to provide what they consider to be futile treatment -- individuals don't get to demand that hospitals and physicians provide treatment that the professionals don't feel is indicated.
Individuals have the right to make their own choice from among the treatent options presented to them, but there is no US law that requires hospitals or physicians to provide what they consider to be futile treatment -- individuals don't get to demand that hospitals and physicians provide treatment that the professionals don't feel is indicated.
Ah, if ONLY this were true! Yes, no US law requires this, but it's extremely common....expected, actually....that utterly futile, utterly useless and very expensive treatments WILL continue to be carried out at a family's behest. How many times have we seen families threatening to SUE if Grandma doesn't have "everything done for her"? Families typically equate failure to continue futile treatment with neglect.....quite wrong, but still they do, which means that suit-fearing physicians will continue to say "what the heck, keep Grandma getting CPR until she cracks apart completely". Paraphrased, of course
And let's face it, we wouldn't have a DEAD GIRL lying in a hospital bed using INSANE amounts of expensive resources if it were not for a demanding family insisting they do this very thing. Jahi McMath, anyone?
Individuals have the right to make their own choice from among the treatment options presented to them, but there is no US law that requires hospitals or physicians to provide what they consider to be futile treatment -- individuals don't get to demand that hospitals and physicians provide treatment that the professionals don't feel is indicated.
What constitutes futile care is a huge debate all by itself. Physicians and other medical professionals, along with patient advocacy groups and medical ethicists, do not agree (i.e. there is no consensus) on the point at which care becomes "futile," or even on a definition of "futile care." Hospital ethics committees can be helpful when there is disagreement between the physician and patient/family wishes in regard to treatment, and can ensure that the patient/family 's position is fairly represented. There is the potential for much conflict of interest between the patient/family interests and the physician/hospital interests. So yes, patients and their families do have a voice in these decisions via hospital/facility ethics committees.
What constitutes futile care is a huge debate all by itself. Physicians and other medical professionals, along with patient advocacy groups and medical ethicists, do not agree (i.e. there is no consensus) on the point at which care becomes "futile," or even on a definition of "futile care." Hospital ethics committees can be helpful when there is disagreement between the physician and patient/family wishes in regard to treatment, and can ensure that the patient/family 's position is fairly represented. There is the potential for much conflict of interest between the patient/family interests and the physician/hospital interests. So yes, patients and their families do have a voice in these decisions via hospital/facility ethics committees.
Susie2310, I often wrong, but I sense that you are young, or inexperienced, or both. You are right in the abstract but, wrong in the end. Ethics committees aren't helpful in many cases because there isn't concrete agreement on what it ethical in each case. We have the ability to do harm, a lot of harm. You propose that patients actually get all the information they need to make informed decisions? That's an abstract ideal. In reality, they're getting different answers from different specialists. Hospitals have to make decisions for people daily because some people elect treatments for a variety of reasons - one of this is pressure from family members who have no idea what kind of suffering we can inflict. I don't argue with my plumber because it's not my specialty. Sometimes I have to let it go.
Susie2310, I often wrong, but I sense that you are young, or inexperienced, or both. You are right in the abstract but, wrong in the end. Ethics committees aren't helpful in many cases because there isn't concrete agreement on what it ethical in each case. We have the ability to do harm, a lot of harm. You propose that patients actually get all the information they need to make informed decisions? That's an abstract ideal. In reality, they're getting different answers from different specialists. Hospitals have to make decisions for people daily because some people elect treatments for a variety of reasons - one of this is pressure from family members who have no idea what kind of suffering we can inflict. I don't argue with my plumber because it's not my specialty. Sometimes I have to let it go.
Subee, I am neither young nor inexperienced. And patients lives are not abstractions. They are very real and concrete to the individuals concerned and their families. Patients and their families have the right to make their own decisions about their health care. They have the right to make the decisions they believe are best for them, even if health care providers believe the decisions are unwise. Yes, the health care system is imperfect, and patients receive information from varying specialists. They have the right to evaluate that information for themselves, if they wish to do so, and determine which course of action they wish to take. Of course, if patients/families wish, they may choose to follow their physician/s recommendations completely. You may decide what is beneficial or harmful for you, but not for other people. You are right that there isn't concrete agreement about what is ethical in many cases. What often ensues is compromise. I said that ethics committees can be helpful for patients and their families. In my earlier posts I referred to patients and their families receiving sufficient information to make informed decisions.
Why do you feel that you should make decisions for other people?
Specializes in NICU, PICU, Transport, L&D, Hospice.
toomuchbaloney,
There is an interesting article in Health Leaders Media titled "Hospitals' Fear of 30-Day Penalties May Speed Hospice Admissions", dated June 6, 2013.
The federal government cannot run out of money.
Nurses are not bound by duty to force information on patients if they indicate they do not wish to hear the information, or to insist that patients make choices about palliative care or hospice if they are not ready to. In my opinion this is against our Nurse's Code of Ethics.
There are situations when curative care will no longer yield positive results for certain people. That is indisputable. But even in these situations, I do not believe in forcing information on people that they are unready to receive, or pressuring people into making choices about palliative care that they are unready to make. These discussions, when truly appropriate, must be done considerately, not coercively or forcefully, with respect shown for the patient's/family's choices and decisions. If the patient/family say they do not wish to have the discussion, there is your answer, and it is to be respected. If the patient/family say they wish to continue to pursue curative care; there is your answer. The patient, with chronic illnesses, has the right to make their own decision, without being continuously questioned and prompted to choose palliative care or hospice.
Nurses are not "bound by duty" to force information upon patients, we are in my view, bound by duty to educate our patients and families on the information they require with which to make informed decisions. They don't always want info on diet or exercise or medications, etc, but that does not relieve us from the responsibilities of our profession to make that info available to them in an understandable form.
Please note that I in no way suggested that we force or pressure our patients or their families to make any sort of decisions about palliative care or end of life care. Patients and families will choose what they will when they will. We will honor their choices after we have provided them with the information needed to make an informed choice.
Clearly there are ways to provide information to folks without coercing them. Surely you agree that providing needed information does not equate to being "forceful" or disrespecting the patient or family choices.
If the patient is terminal and care options include palliative and hospice care I will inform them of those options. If they do not wish to discuss it further after they have been provided the needed information, fine...my job is done. If they want to pursue curative care, fine...they get to make those informed decisions and again, my job is done.
As the end of life patient continues in visits with the provider they will be assessed for progress toward their goals and that progress (or lack of) will influence the health education that remains a necessary and integral part of the health care of the individual. If the patient, in that primary care setting is not progressing toward their chosen goals then that must be addressed.
Providing information about hospice or palliative care does not necessarily equate with "being continuously questioned and promted to choose palliative care or hospice". No prompting should be occuring, just educating and informing.
We need to provide information for the benefit of the patient, not to placate family nor the emotions of the provider.
Respect for the self actualization of the patient is central to end of life care. Are you assuming that if one is straightforward in their educational approach about end of life care that they are necessarily forceful or coersive or prompting and not respectful of patient/family decisions?
In my many years of experience as a professional nurse I have encountered many many people who were uncomfortable with and did not particularly want to talk about death and care at end of life. I have encountered many more who were uncomfortable with the topic but who greatly appreciated having an "honest" discussion of options rather than sugar coating the topic and behaving as if all decisions could be postponed until a later date. I have encountered family who do not want their alert cognitively intact loved one told of their prognosis or spoken to about hospice services. I have worked with family who want "everything done" even when no provider will accomodate that wish because their loved one is not going to be medically benefitted from the surgery or the chemo or the new pharmaceutical that they saw advertised on tv. Poorly informed people often want all sort of things that are not practical, possible, or advisable. If we don't explore those things with them at some point I guess we shouldn't be surprised by their persistance in expecting the unachievable.
Our chronically ill patients do have the right to self determine their end of life care. They just need to make those decisions (preferrably from an informed position) about resusitation and intubation etc while they are still able and before they come into the ED obtunded and actively dying with panicked family in tow who want "everything" done.
Nurses are not "bound by duty" to force information upon patients, we are in my view, bound by duty to educate our patients and families on the information they require with which to make informed decisions. They don't always want info on diet or exercise or medications, etc, but that does not relieve us from the responsibilities of our profession to make that info available to them in an understandable form.
Please note that I in no way suggested that we force or pressure our patients or their families to make any sort of decisions about palliative care or end of life care. Patients and families will choose what they will when they will. We will honor their choices after we have provided them with the information needed to make an informed choice.
Clearly there are ways to provide information to folks without coercing them. Surely you agree that providing needed information does not equate to being "forceful" or disrespecting the patient or family choices.
If the patient is terminal and care options include palliative and hospice care I will inform them of those options. If they do not wish to discuss it further after they have been provided the needed information, fine...my job is done. If they want to pursue curative care, fine...they get to make those informed decisions and again, my job is done.
As the end of life patient continues in visits with the provider they will be assessed for progress toward their goals and that progress (or lack of) will influence the health education that remains a necessary and integral part of the health care of the individual. If the patient, in that primary care setting is not progressing toward their chosen goals then that must be addressed.
Providing information about hospice or palliative care does not necessarily equate with "being continuously questioned and promted to choose palliative care or hospice". No prompting should be occuring, just educating and informing.
We need to provide information for the benefit of the patient, not to placate family nor the emotions of the provider.
Respect for the self actualization of the patient is central to end of life care. Are you assuming that if one is straightforward in their educational approach about end of life care that they are necessarily forceful or coersive or prompting and not respectful of patient/family decisions?
In my many years of experience as a professional nurse I have encountered many many people who were uncomfortable with and did not particularly want to talk about death and care at end of life. I have encountered many more who were uncomfortable with the topic but who greatly appreciated having an "honest" discussion of options rather than sugar coating the topic and behaving as if all decisions could be postponed until a later date. I have encountered family who do not want their alert cognitively intact loved one told of their prognosis or spoken to about hospice services. I have worked with family who want "everything done" even when no provider will accomodate that wish because their loved one is not going to be medically benefitted from the surgery or the chemo or the new pharmaceutical that they saw advertised on tv. Poorly informed people often want all sort of things that are not practical, possible, or advisable. If we don't explore those things with them at some point I guess we shouldn't be surprised by their persistance in expecting the unachievable.
Our chronically ill patients do have the right to self determine their end of life care. They just need to make those decisions (preferrably from an informed position) about resusitation and intubation etc while they are still able and before they come into the ED obtunded and actively dying with panicked family in tow who want "everything" done.
toomuchbaloney,
I think you will agree that the language of your earlier post that I copied below, which I replied to, conveyed a meaning that was not nearly as considerate of the patient/family and their wishes as you now assert in your post above.
I believe that we are obligated to educate patients and their families about expected outcomes of their chronic diseases whether or not they initiate the discussion. We also, as health professionals must address end of life issues and the notion of palliative care and hospice, again, regardless of whether or not the patient and/or family has initiated the discussion. It is our job to provide people with the information that they require to make informed decisions. Many of us have experienced the wrath of the family who does not want to hear that their loved one is dying. Many of us know that such wrath does not remove our obligation to provide them and the patient specifically with ALL of the facts surrounding their illness and the likelihood of recovery or death. For too long the medical field has preferred to sugar coat talk of death after waiting until the very last moment in care to discuss it. That practice is outdated, centered on the professional rather than on the needs of the patient, and is costing our health system millions of $$ in futile care.
Yes, there will be some folks who are "not ready" to hear about palliative care or hospice yet. But we mention it anyway and by the time we mention it AGAIN, some of them have changed their minds or are ready to hear more information. People don't always know what they need to know. Some of them are under the impression that they "have time" to make the choices about hospice when they really don't have much time at all and they are wasting their time and resources trying to keep living when all they are doing is trading their comfort and peace for a vague sense of "hope".
toomuchbaloney
16,029 Posts
I believe that we are obligated to educate patients and their families about expected outcomes of their chronic diseases whether or not they initiate the discussion. We also, as health professionals must address end of life issues and the notion of palliative care and hospice, again, regardless of whether or not the patient and/or family has initiated the discussion. It is our job to provide people with the information that they require to make informed decisions. Many of us have experienced the wrath of the family who does not want to hear that their loved one is dying. Many of us know that such wrath does not remove our obligation to provide them and the patient specifically with ALL of the facts surrounding their illness and the likelihood of recovery or death. For too long the medical field has preferred to sugar coat talk of death after waiting until the very last moment in care to discuss it. That practice is outdated, centered on the professional rather than on the needs of the patient, and is costing our health system millions of $$ in futile care.
Yes, there will be some folks who are "not ready" to hear about palliative care or hospice yet. But we mention it anyway and by the time we mention it AGAIN, some of them have changed their minds or are ready to hear more information. People don't always know what they need to know. Some of them are under the impression that they "have time" to make the choices about hospice when they really don't have much time at all and they are wasting their time and resources trying to keep living when all they are doing is trading their comfort and peace for a vague sense of "hope".